A Converstation on Global Health Care Issues

Health care policy decisions in Washington can have profound global implications, according to Julio Frenk, M.D., president, University of Miami (pictured left), and the opening speaker at the School of Business' sixth annual Business of Health Care Conference.

“The U.S. health system is influenced by global forces," said Frenk, citing the threat of infectious diseases like Zika and Ebola, and ability of foreign health care professionals to choose locations for their training and practice. “Health care is the quintessential example of a ‘glo-cal’ sector where services are delivered by local hospitals, doctors and nurses who are deeply connected with global networks,” he added.

In the opening session, "A Conversation on the Election and Global Health Care Issues," Frenk posed a series of questions to Ashish Jha, M.D., K.T. Li Professor of International Health, Harvard University, and director, Harvard Global Health Institute (pictured right).

"President Trump has articulated a slogan, 'Americanism, not globalism,' while the Republican-controlled Congress has focused on how to 'repeal and replace' Obamacare," Frenk said. "How do you connect these two themes?"

In response, Jha said the nation is at an "inflection point" regarding health care policy. However, a policy aimed at "putting America first" could jeopardize the nation's health, well-being and security.

"Every aspect of U.S. health care has global components, including the foreign physicians and nurses who practice here, the medications made outside our country, and the knowledge we export around the world," Jha said. “Would we be better off by shutting our borders? The answer is a resounding no. Instead we must make investments in public health to protect the American people in an interdependent world."

Expanding on those topics, Jha said about 25 percent of U.S. physicians and nurses were trained abroad. "This is a mobile field of talent, where professionals are in demand around the world," he said. "And it's not just professionals who can move around. Patients also seek out lower-cost setting to receive elective services."

High-cost U.S. medications and devices are an ongoing issue in U.S. politics, Jha said. But they also create markets for counterfeits that cross borders, both legally and illegally.

A "repeal and replace" scenario that results in more Americans purchasing high-deductible coverage could increase the outbound flow of U.S. patients. "There are already foreign clinics that cater to the wealthy," Jha said. "When middle-class Americans face a $12,000 deductible, that market may change dramatically."

Providing foreign assistance

For decades, U.S. presidents have provided bipartisan support for health care as an instrument of foreign aid and "soft diplomacy," Frenk said. "U.S. funding has had a major impact in access to AIDS treatment around the world, helping to deal with a global health crisis. What about the new administration's appetite for future foreign assistance projects?"

Jha said U.S. aid has been enormously successful in saving lives in undeveloped regions of the world. "But even if you don't feel that's enough to justify spending, that money has been well spent in terms of its impact on the stability of these countries and their attitudes toward America," he said. "Everyone knows that 'failed states' pose a serious threat to our national security. This is a much better way to protect our country than sending in the military."

Noting that health care is the largest sector of the U.S. economy, Jha added America is competing for talent around the world. "One of the ways we do that is being the 'shining city on the hill' as President Reagan said. If we retreat from that moral position, we will be hurt more than other countries."

Continued U.S. investment in global public health is also essential for identifying and containing outbreaks of infectious diseases, reducing the risk for Americans, Jha said. “Ebola was a warning to us,” he said. “We got lucky, because this disease doesn’t spread that easily. But 100,000 people fly into the U.S. every day, so it’s impossible to keep out an infectious disease.”

Jha likened the threat of pandemics to that of a fire in a crowded city neighborhood. Building a protective wall around one home is unrealistic, he said. Instead, the U.S. should be sure other countries have the “smoke detectors and fire extinguishers” they need so a problem doesn’t engulf the entire neighborhood.

For most Americans, health care is something that involves diagnosis and treatment by a local provider, Frenk said. “But we cannot forget about the public health aspect, which is invisible to most people unless something goes wrong. These professionals are working every day preventing outbreaks and promoting better health.”

Frenk added that much of the conversation in Washington revolves around the “upstream” aspects of health care, like the costs of treatment and medications. But investments in disease prevention and wellness can help address the “downstream” obstacles and deliver a powerful return on investment by keeping Americans healthy.

During the Q&A session after the conversation, Jha was asked about the potential for virtual diagnostic and treatment services to deliver preventive care. “In the next five to 10 years, I believe we will see a transformation in how health care is delivered,” he said. “If you are a fan of health care technology, the next decade will be yours.”